The first objective of this proposed study is to conduct a detailed analysis of all malpractice claims involving health care providers in Maryland during 1977-1985. The principal source of data will be open and closed claims filed with the Maryland Health Claims Arbitration Office. (Estimated N= 3700) The study will examine patient, physician and hospital characteristics associated with number and type of malpractice claims, seriousness of claims, method of claim resolution, outcome of the arbitration process, size of awards made by arbitration panels, costs associated with the arbitration process, outcome of court appeals, and length of time required for claim resolution. A second objective is to identify factors associated with variation in the malpractice claims experience of Maryland acute care general hospitals. It is anticipated that the number and seriousness of claims within institutions will be associated with the volume of 'high risk' procedures; with patient characteristics such as casemix, average age, and socioeconomic status; and with characteristics of providers such as specialty and board certification. A central question is the extent to which, after taking these variables into consideration, hospital variation in claims activity can be explained in terms of factors such as the state of development and degree of comprehensiveness of quality assurance and risk management efforts. A third aim is to provide a detailed description of hospital incidents generating malpractice claims by DRG, and to examine factors associated with hospital variation in claims activity for 'high risk' DRGs. It is anticipated that results from this study will aid legislative efforts to improve the health claims arbitration process, and will help Maryland hospitals, insurers, and provider groups to develop better targeted educational programs and demonstration projects in the areas of quality assurance/risk management. The proposed study is part of a larger effort among physician, insurer, and hospital groups in the State to develop joint educational and demonstration projects for the purpose of reducing the number and/or the seriousness of incidents involving Maryland physicians.